The Holy Grail Of Trauma Management

One of the great frustrations of trauma care is that paramedics can not replace blood. Sure, we can infuse any number of volume expanding solutions, but none of them can carry oxygen, which is one of the functions of blood. For trauma survival it’s the function that we care about. Over the past 20 or so years there have been a number of attempts to produce an oxygen carrying synthetic blood product. None have been successful and we still rely on donated blood for transfusions as we have since the early 1800s. Sure the technology has improved, but the product still comes from the same source. Compounding the problem is the difficulty researchers have in getting FDA approval for trials and resistance from some “community activists” because the majority of trauma victims in urban areas (where most of the big teaching hospitals are located)tend to be minorities.

Thus, for trauma care in the field and in the hospital, the development of a usable oxygen carrying blood product has been in effect The Holy Grail of trauma management.

One of the only good things, maybe the only good thing that comes from war is rapid advances in technology. At the beginning of World War II, technology had not advanced much since the end of World War I. By the end of World War II, medicine, aeronautics, rocketry, maritime technology, and many other fields had leaped forward tremendously. The same thing happened during the Korean War, where forward surgical hospitals, helicopter evacuation, and surgical techniques advanced. That continued during the Vietnam War.

Which brings us to the 21st Century. The US has been at war since late 2001. First Afghanistan, then Iraq, now Afghanistan again. Military (and civilian) medicine has had to re-learn some lessons from previous wars, but more importantly surgical technique and technology has advanced rapidly. Some of this has spilled over to the civilian setting, just as it did during Vietnam, and some of it hasn’t, yet. It will, once costs come down to relatively affordable levels.

Perhaps ranking behind only bullets and water, blood is one of those things you really don’t want to run out of on the battlefield. But better battlefield medicine — as well as some of the more malicious combat techniques employed by insurgent guerrilla fighters — mean more soldiers are surviving their injuries, and that puts military blood banks in a bind. But a DARPA program launched in 2008 is coming to fruition, potentially providing medics an endless stream of universally accepted O-negative blood through a process known as blood pharming.

This is not a synthetic, but a human blood based (cord blood) product. If this works, it’s going to revolutionize care of trauma patients, in the field, in the ED, and in operating rooms. If all it takes to move this into the field is refrigeration, the solution is already available.

This is exciting stuff, believe me. Man made blood, with none of the risks inherent in blood donated by adults, in large quantities is going to positively effect thousands of patients a year.

An active battlefield is a really inconvenient place to lose a lot of blood. But naturally that’s exactly where soldiers sustain the bulk of their life-threatening injuries, so Darpa is committing $9.9 million to finding drugs that can extend the “golden hour” — the one-hour window that medics generally have to bring a soldier back from severe blood loss — by as much as six hours.

Don’t get hung up on the “golden hour” reference, I don’t want to start that debate again. Think of being able to start an IV, give an oxygen bearing blood product OR being able to slow down a patient’s metabolic processes so much that they stop bleeding, their oxygen demand drops, and they can be kept in stasis until the surgeons can fix their injuries. Finally, we will be able to do more than try to stop the bleeding and give oxygen for trauma patients.

The TIPS researchers anticipate a working treatment within 18 months. If successful, a suspended animation cocktail could save countless lives not only on the battlefield, but back here at home as well. EMTs armed with syringes of suspended animation juice could vastly alter survival rates at the scenes of car crashes, natural disasters and other emergencies, giving civilian medics their own weapon in the battle against time.

Comments

I had a conversation about thisa while back with my friend Squid who is in Afghanistan. And he told me that the synthetic blood product is coming soon, but not soon enough for their liking.I hadn't heard about the "suspended animation" drugs, but I like the idea.

All About Me

After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it?
I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs.
I still write about EMS, but I'm adding more and more non EMS subject matter.
Thanks for visiting. Read More…